STRESS IN PEDIATRIC PATIENTS--THE EFFECT OF PROLONGED HOSPITALIZATION.

Long-term hospitalization emotionally impacts any patient, especially children, and is defined as a long period of time during which the patient is hospitalized and experiences isolation from his or her family, friends and home. Stressful situations trigger a nonspecific response that involves multiple physiological mechanisms. Currently, because of the complexity of these mechanisms, there are no laboratory markers that allow the quantification of the stress intensity felt by the patient. Laboratory determinations currently used in evaluating the response to stress are neuroendocrine, immunological and metabolic. The neuroendocrine system is the first to respond to stressful events. Stress stimulates the hypothalamus, leading to the release of CRH, which stimulates the pituitary gland to produce ACTH. Chronic stress directs the synthesis towards cortisol, which may lead to hypo secretion of the other adrenal steroid hormones. The hospital and the disease are stressors for children and caregivers, since stress can interfere with the normal development of young patients, affecting them in the long term. Admitting a child to hospital means interrupting his or her normal daily life and changing the environment that is familiar to him or her. Therefore, the involvement of the family doctor is very important, as many conditions can be solved by visiting his or her office and thus eliminating the need for hospitalization in a pediatric hospital. If, however, the nature of the condition requires that the child should be seen by a pediatrician, the period of hospitalization should not be much extended so as to prevent the appearance of other possible problems that might influence the child's state.

VACCINATION--COLLECTIVE RESPONSIBILITY OR VIOLATION OF RIGHTS?

Vaccination is considered to be the most effective and the cheapest medical intervention through which individual and collective immunisation is achieved. Statistics show that, at present, immunisation annually saves 400 million lives and protects approximately 750,000 children against disabilities of varying degrees. Approximately 80% of worldwide children are vaccinated against diphtheria, tetanus, pertussis, polio, measles, etc.; these diseases used to be considered incurable in the past. Vaccines help the body to produce antibodies; they help the immune system to detect germs and inactivate their cells. The immunological protection is installed after a variable period of time following the inoculation and is long lasting. Immunisations can be achieved in several ways: through national immunisation campaigns with general recommendation--they may be compulsory, optional or prophylactic (for the diseases for which a vaccine is available); vaccinations not included in the compulsory immunisation programmes; they may also be targeted to the contagious infectious outbreaks or to groups of population in certain situations. There is no guarantee that a vaccine will provide 100% protection. However, it will significantly reduce the risk of getting an infection. Vaccines have side effects which can be divided into reactions triggered by the vaccine or reactions exacerbated by it, without a causal relationship to the vaccine.

Atypical presentation of systemic lupus erythematosus: parotitis and secondary Sjogren's syndrome. Case report.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by auto antibodies directed against self-antigens, immune complex formation and immune deregulations and may affect joints, skin, kidneys, heart, lungs, nervous system, and immune system. The onset can be variable and the symptoms can occur for many years. Parotitis as the initial manifestation of systemic lupus erythematosus (SLE) is a rare condition and can be associated with Sjogren's syndrome. In this article we present the case of a young patient who was diagnosed with Sjogren's syndrome retrospectively, after she met the criteria for SLE.

[Allergic comorbidities in bronchial asthma, in children]. / Comorbiditati alergice în astmul bronsic la copil.

Bronchial asthma is the most frequent chronic disease of childhood. The association of this disease with allergic rhinitis increases the prevalence and severity of bronchial asthma to 60% compared with 2% in subjects without allergic rhinitis. Food allergy can be expressed in a variety of respiratory symptoms, especially when IgE mediated immune responses are involved. In children, the prevalence of bronchial asthma associated with food induced atopic eczema is 2-8% and respiratory clinical picture can be a component of the multisystem anaphylactic reaction or of chronic respiratory disease like bronchial asthma, serous otitis. The association of other allergic comorbidities, like sinusitis, ocular allergies, lymphoid hypertrophy, sleep obstructive apnoea, leads to the conclusion that allergic bronchial asthma (extrinsic) is a systemic disease, with onset at any age, and the dominant clinical feature depends on the child's genetic pattern.

Genetic and demographic features of X-linked agammaglobulinemia in Eastern and Central Europe: a cohort study.

Primary immunodeficiency disorders are a recognized public health problem worldwide. The prototype of these conditions is X-linked agammaglobulinemia (XLA) or Bruton's disease. XLA is caused by mutations in Bruton's tyrosine kinase gene (BTK), preventing B cell development and resulting in the almost total absence of serum immunoglobulins. The genetic profile and prevalence of XLA have not previously been studied in Eastern and Central European (ECE) countries. We studied the genetic and demographic features of XLA in Belarus, Croatia Hungary, Poland, Republic of Macedonia, Romania, Russia, Serbia, Slovenia, and Ukraine. We collected clinical, immunological, and genetic information for 122 patients from 109 families. The BTK gene was sequenced from the genomic DNA of patients with a high susceptibility to infection, almost no CD19(+) peripheral blood B cells, and low or undetectable levels of serum immunoglobulins M, G, and A, compatible with a clinical and immunological diagnosis of XLA. BTK sequence analysis revealed 98 different mutations, 46 of which are reported for the first time here. The mutations included single nucleotide changes in the coding exons (35 missense and 17 nonsense), 23 splicing defects, 13 small deletions, 7 large deletions, and 3 insertions. The mutations were scattered throughout the BTK gene and most frequently concerned the SH1 domain; no missense mutation was detected in the SH3 domain. The prevalence of XLA in ECE countries (total population 145,530,870) was found to be 1 per 1,399,000 individuals. This report provides the first comprehensive overview of the molecular genetic and demographic features of XLA in Eastern and Central Europe.

[X-linked Bruton congenital agammaglobulinemia. Case report]. / Agamaglobulinemie congenitala legata de x Bruton. Prezentare de caz.

Congenital agamaglobulinemia is a B-cell deficiency caused by tirosin-kinase gene mutations. This article presents the case of a 2 years and 6 months old boy with a history of multiple respiratory infections, which also associates a malabsorbtion syndrome. The patient presented for symptoms of arthritis. After performing protein electrophoresis, the extremely low gamma fraction pointed out a hidden immunodeficiency. Gene analysis was performed in the Department of Pediatric Immunology of Debrecen University, Hungary and thus the final diagnosis was determined. Arthritis and respiratory symptoms improved after immunoglobulin treatment.

[Osteopenia in children with juvenile idiopathic arthritis]. / Osteopenia la copiii cu artrita juvenila idiopatica.

UNLABELLED: The aim of the study was to evaluate the presence and etiopathogenesis of osteopenia in 41 children with Juvenile Idiopathic Arthritis (JIA). METHODS: Bone status was evaluated by quantitative ultrasound using a Sunlight Omnisense 7000s Ultrasound Bone Sonometer. Measurements were performed at the distal radius and midshaft tibia. Results were obtained as Speed of sound (SOS) and Z-score. We used standardised clinical evaluation (modified Giannini's criteria, CHAQ). ESR, Fibrinogen, serum calcium, magnesium, alkaline phosphatase, protein electrophoresis, 25-OH vitamin D (RIA) and urinary Hydroxyproline were obtained in all patients. Osteopenia was present in 15 (36.5%) patients. Statistical analysis was performed with SPSS 13.0. RESULTS: Age, sex, age at onset, disease duration, life standards and duration of corticotherapy and methotrexate treatment were not related to osteopenia in our study. The disease activity, evaluated by clinical criteria, ESR and Fibrinogen, was strongly associated with osteopenia (p<0.001). Nutritional status was an independent risk factor for osteopenia (p<0.001). Low serum calcium (p=0.034), magnesium (p=0.010), 25-OH vitamin D (p=0.091) and alkaline phosphatase (p=0.31) were more frequent in patients with osteopenia. Hydroxyproline was increased in all patients with osteopenia (p<0.001). CONCLUSIONS: Osteopenia was a frequent (36.5%) complication of JIA in our study. The disease activity and nutritional status were the most important risk factors for osteopenia. The increase of bone reabsorption was the main pathogenic mechanism of osteopenia in our study. Calcium and magnesium deficits were related to osteopenia. Decrease of bone synthesis was not associated with osteopenia in the present study.

[The global survival rate calculated by Kaplan-Meier method in children with malignant lymphomas]. / Supravietuirea globala în limfoame maligne la copil apreciata prin metoda Kaplan-Meier.

The Kaplan Meier method is being used in oncology in order to calculate the survival rate during/at the end of the study. The purpose of this study is the assessment of the survival period referred to the clinical and histopathological state, laboratory findings, the diagnostic and treatment time. The material of the study is a LIMCO group (n=308 cases) hospitalized in the Oncology Department of the Children's Clinical and Emergency Hospital "Sf. Maria", Iasi between 1980-1995. The LIMCO group was divided in 2 smaller groups: LMH group (110 cases) and a LMNH group (198 cases). The results statistical analysis was made by chi2, Long-Rank and Breslow test. The results established a series of favorable LIMCO prognostic factors referred to the clinical state I-II, the histopathological type, normal or pathological laboratory findings at the first admission and the quality of the remission after the multimodal treatment.

[Clinical and epidemiologic considerations in the role of newborn diseases causing asthma in children]. / Consideratii clinico-epidemiologice privind implicarea patologiei neonatale în inducerea astmului bronsic la copil.

The authors present results of a multidisciplinary study in 712 children with asthma concerning the role of certain newborns events and the role of feeding in the onset of disease: resuscitation during the delivery--82.68%, respiratory distress--75.5%, Apgar score = 7 - 58.56%, bottle-feeding 50.50%, multi-pregnancy--44.23%, abnormal pregnancy--20.11%, premature infant and small for gestational age infant 10.60%, mother age less then 20 years 8.6%.

[The effects of inhaled corticoids on bone density in asthmatic children]. / Efectele corticoterapiei inhalatorii asupra densitatii osoase la copiii cu astm bronsic.

OBJECTIVE: To evaluate bone status of asthmatic children on chronic inhaled corticoid therapy. METHODS: Bone densitometry was performed by Quantitative ultrasound (QUS) of the distal radius in 74 asthmatic children, evaluating Z-score; serum levels of 25 hydroxyvitamin D were measured in 10 cases. RESULTS: 28 of 74 children had osteopenia, defined as Z scores lower than -1. Statistic analyzes showed a significant correlation (p <0.05) of osteopenia with the duration of inhaled corticoid therapy (CSI), the absence of correlation with the dose of CSI, age, sex, severity step and duration of the disease. 25 hydroxyvitamin D was low in 8 of the 10 cases with osteopenia. Osteopenia was present in 7 children who were not under CSI, but have received multiple trials of oral corticoids for severe exacerbations. CONCLUSIONS: Osteopenia was present in 52% of children that were under inhaled corticoids for more than 12 months and it correlated with the duration of CSI, but not with the daily dose. Systemic corticoid use is a significant cause of osteopenia in asthmatic children.

[Global survival rate calculated by Kaplan-Mayer method in children with malignant lymphomas]. / Supravietuirea globala în limfoame maligne la copil apreciata prin metoda Kaplan Maier.

The Kaplan Maier method is being used in oncology in order to calculate the survival rate during/at the end of the study. The purpose of this study is the assessment of the survival period referred to the clinical and histopathological state, laboratory findings, the diagnostic and treatment time. The material of the study is a LIMCO group (n = 308 cases) hospitalized in the Oncology Department of the Children's Clinical and Emergency Hospital "Sf. Maria", Iasi between 1980-1995. The LIMCO group was divided in 2 smaller groups: LMH group (110 cases) and a LMNH group (198 cases). The results statistical analysis was made by chi 2, Long-Rank and Breslow test. The results established a series of favorable LIMCO prognostic factors referred to the clinical state I-II, the histopathological type, normal or pathological laboratory findings at the first admission and the quality of the remission after the multimodal treatment.

[Hemangioendothelioma in children]. / Hemangioendoteliom la copil.

The hemangioendothelium is a vascular tumor rarely seen in the pediatric practice. This case underlines the difficulty that lies in establishing a differential diagnosis with a localized adenopathy when this vascular tumor is developing inside a ganglionic region. The surgical treatment followed by interferon therapy determined a favorable evolution in this case because the hemangioendothelium is a vascular borderline tumor. Still, there are cases that recur, metastasize and have an evolution towards death.

[Acute diarrhea associated with Cyclospora cayetanensis]. / Boala diareica acuta cu Cyclospora cayetanensis.

Acute diarrhea is a major problem with high morbidity and mortality rates in developing countries, especially in children. Complex laboratory investigations are required to define the etiology because of the broad spectrum of etiological agents and the non-specific clinical signs. In the last decade, Cyclospora cayetanensis--a new acid-fast coccidian species--was pointed to be the cause of watery self-limited or prolonged diarrhea in immunocompetent and immunocompromised patients, with very good evolution after treatment with co-trimoxazole. Unlike Cryptosporidium parvum, nonsporulated Cyclospora oocysts are eliminated in feces, with no risk of human to human transmission. Cyclospora cayetanensis is widely spread, producing endemic infections, in Asia and South America and was reported to produce infections in foreign travellers in these areas and epidemic outbreaks of foodborne diarrhea. We describe the first case of acute diarrhea associated with Cyclospora cayetanensis in an immunocompetent child admitted to Iasi "Sf. Maria" Hospital.

[Systemic lupus erythematosus in children. I: clinical and age dependent evolutive characteristics]. / Lupusul eritematos sistemic (LES) la copil. Nota I: Particularitati clinice si evolutive dependente de vârsta.

The individualized, retrospective study of 14 children with SLE (4-16 years) pointed out a series of clinical and age dependent evolutive characteristics. Below the age of 10 years old (lot 1:2 boys and 4 girls), SLE started as a prolonged fever syndrome (5-16 weeks) in the majority of cases; for 2 children the severe poliarthritis resistant to the AINS therapy is associated with the durable absence of the antinuclear seric antibody (ANA). For the same age group a high frequency of neurological manifestations (5/6 cases) was noticed. After the age of 10 years old (lot II: 8 girls) the symptoms incidence at debut is close to the one of the adult, the cutanat and renal manifestations in evolution were dominant (7/8 cases). The 7 months absence of ANA characterises a case that started with hepatomegaly, severe neurological and physiological manifestations and microscopic hematuria. The follow-up lasted until the age of 16 years old; the patients were clinically tested for severe renal complication. The correct application of the classical criteria of diagnostic (ARA, 1982), and in the last few years the application of the ponderat score (Mayer, 1998), allows us to establish an early diagnostic and a rapid evaluation of a relapse, therefore influencing the treatment.